Type 2 Diabetes

Topic Overview

What is type 2 diabetes?

Type 2 diabetes happens when your body can't use insulin the right way or when the pancreas can't make enough insulin.

Insulin is a hormone that helps the body's cells use sugar (glucose) for energy. It also helps the body store extra sugar in muscle, fat, and liver cells. Without insulin, this sugar can't get into your cells to do its work. It stays in your blood instead. Your blood sugar level then gets too high.

High blood sugar can harm many parts of the body, such as the eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health problems (complications).

Type 2 diabetes is different from type 1 diabetes. In type 1 diabetes, the body's immune system destroys the cells that release insulin, so that over time the body can't produce insulin at all. In type 2 diabetes, the body still makes some insulin, but it can't use it the right way.

What causes type 2 diabetes?

You can get type 2 diabetes if:

Your body doesn't respond as it should to insulin. This makes it hard for your cells to get sugar from the blood for energy. This is called insulin resistance.

Your pancreas doesn't make enough insulin.

If you are overweight, get little or no exercise, or have type 2 diabetes in your family, you are more likely to have problems with the way insulin works in your body. Type 2 diabetes can be prevented or delayed with a healthy lifestyle, including staying at a healthy weight, making healthy food choices, and getting regular exercise.

What are the symptoms?

Some people don't have symptoms, especially when diabetes is diagnosed early. This is because the blood sugar level may rise so slowly that a person may not know that anything is wrong.

The most common symptoms of high blood sugar include:

Feeling very thirsty.

Urinating
more often than usual.

Feeling very hungry.

Having
blurred vision.

You can get high blood sugar for many
reasons, including not taking your diabetes medicines, eating more than usual
(especially sweets), not exercising, or being sick or under a lot of stress.

If you're taking diabetes medicine, you can also have problems with low blood sugar. These symptoms include:

Sweating.

Feeling
weak.

Feeling shaky.

Feeling very hungry.

How is type 2 diabetes diagnosed?

If your doctor thinks that you have type 2 diabetes, he or she will ask you questions about your medical history, do a physical exam, and order a blood test that measures the amount of sugar in your blood.

How is it treated?

The key to treating type 2 diabetes is to keep blood sugar levels controlled and in your target range.

All of the following help to lower blood sugar:

Making healthy
food choices. Try to manage the amount of carbohydrate you eat by spreading it out over the day.

Losing weight, if you are overweight

Getting regular exercise

Taking medicines, if you need them

It's also important to:

See your doctor. Regular checkups are important to monitor your health.

Test your blood sugar levels. You have a better chance of keeping your blood sugar in your target range if you know what your levels are from day to day.

Keep high blood pressure and high cholesterol under control. This can help you lower your risk of heart and
large blood vessel disease.

Quit smoking. This can help you reduce your risk of heart disease and stroke.

It seems like a lot to do—especially at first. You might start with one or two changes. Focus on checking your blood sugar regularly and being active more often. Work on other tasks as you can.

It can be hard to accept that you have diabetes. It's normal to feel sad or angry. You may even feel grief. Talking about your feelings can help. Your doctor or other health professionals can help you cope.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Decision Points focus on key medical care decisions that are important to many health problems.

If you take insulin, you may have some mornings when your
blood sugar level is very high, even if it was low when you went to bed. This could be caused by
the dawn phenomenon or the Somogyi effect. Talk with
your doctor if this happens. You may need to check your blood sugar during the night to find out why your levels are high in the morning.

High blood sugar

The higher your blood sugar rises, the more likely you are to have symptoms. If you have higher-than-normal blood sugar and don't drink enough liquids, you can get dehydrated. This can make you feel dizzy and weak, and it can lead to an emergency called a hyperosmolar state.

Low blood sugar

When your blood sugar is
too low, it can also cause problems. And it can happen suddenly. Quickly treating low
blood sugar can help you avoid passing out (losing consciousness). You
can pass out when your blood sugar gets very low.
Low blood sugar can also lead to a heart attack.

If you aren't able to tell when your blood sugar is too low (hypoglycemic unawareness), it's a good idea to test your blood sugar often. But you're not likely to get low blood sugar unless you take insulin or other diabetes medicines.

As important as regular testing is, you also need to know what the
results mean and how to use them. "Look for patterns. If your blood sugar is
always high before lunch, take a look at what you had for breakfast. Maybe you
need to make some changes."—Rhonda

What Happens

When you have type 2 diabetes, your body still makes insulin. But as time goes on, your
pancreas may make less and less insulin, which will make it harder to keep your blood sugar in your target range. If your blood sugar gets too high and stays too high for too long, your risk for other health problems increases. Over time, high blood sugar can damage many parts of your body.

Eyes

High blood sugar levels may cause temporary blurred vision. Blurry vision, floaters, or flashes of light may be a sign of
diabetic retinopathy, which can cause severe vision loss.

Feet and skin

You may have less feeling in your feet, which means that you can injure your feet and not know it. Blisters, ingrown toenails, small cuts, or other problems that may seem minor can quickly become more serious.
If you develop serious infections or bone and joint deformities, you may need surgery (even amputation) to treat those problems. Common infections can quickly become more serious when you have diabetes.

Heart and blood vessels

High blood sugar damages the lining of blood vessels. This can lead to stroke, heart attack, or peripheral arterial disease. Erection problems can be an early warning sign of blood vessel disease and may mean a higher risk of heart disease.

Nerves

High blood sugar levels can damage nerves throughout your body. This damage is called diabetic neuropathy.
There are three kinds of diabetic neuropathy:

Diabetic peripheral neuropathy. This is damage to the nerves that sense pain, touch, hot, and cold. This type of nerve damage can lead to a deformity called
Charcot foot. It can also lead to other problems that may require
amputation.

Autonomic neuropathy. This is damage to nerves that control things like your heartbeat, blood pressure, sweating, digestion, urination, and sexual function.

Focal neuropathy. Most of the time, this affects just one nerve, usually in the wrist, thigh, or foot. It may also affect the nerves of your back and chest and those that control your eye muscles.

Kidneys

The kidneys have many tiny blood vessels that filter waste from your blood. High blood sugar can destroy these blood vessels. You won't have any symptoms of kidney damage until the
problem is severe. Then you may notice swelling in your
feet or legs or all over your body.

Hearing

High blood sugar can damage the small blood vessels and nerves in the ear, causing hearing loss.

Teeth

Gum disease can make it harder to keep blood sugar in a target range. And high blood sugar can cause gum disease, loss of teeth, and healing problems in the mouth.

Mental health

Type 2 diabetes can raise your risk of depression. It may be caused by the stress of dealing with diabetes or by the effects that diabetes has on your body.

Being depressed can make it hard to eat healthy foods and to find the motivation to exercise. All of these things lead to higher blood sugar.
By getting help for depression, you'll feel better and may find it easier to stay motivated.

What Increases Your Risk

Risk factors you can't change include:

Family history. If you have a parent, brother, or
sister who has type 2 diabetes, you have a greater chance of developing the
disease.

Age. The risk for getting
prediabetes and type 2 diabetes increases with age.
And the number of children being diagnosed with type 2 diabetes is increasing.
Usually, children who get type 2 diabetes have a family history of the disease,
are overweight, and are physically inactive.

History of
gestational diabetes or having a baby weighing more
than 9 lb (4 kg). Women who
have had gestational diabetes or who have had a large baby are at higher risk
for developing type 2 diabetes later in life.

Low birth weight. People who weighed less than
5.5 lb (2.5 kg) at birth are
more likely to develop type 2 diabetes later in life.

Risk factors you can change include:

Being overweight. Staying at a healthy weight can lower your risk.

Not getting enough exercise. Being active may help your body control blood sugar levels.

Eating a diet that isn't healthy. Making healthy food choices is important to avoid diabetes.

Other health problems can put you at risk for type 2 diabetes. These are
also linked to
obesity and a lack of physical activity:

Metabolic syndrome, a group of abnormal physical
findings related to the body's metabolism.

Prediabetes. Having prediabetes means that you are at risk for type 2 diabetes. It's important to get treatment. If your fasting blood sugar levels are in
the range from 100
mg/dL to 125 mg/dL, you are at increased risk for
type 2 diabetes.footnote 1

If you're worried

To see whether you are at risk for type 2 diabetes, see the website www.diabetes.org/diabetes-basics/prevention/diabetes-risk-test. If you are at risk, you can
discuss with your doctor how to make healthy changes in your life.

If it is hard to tell if you have type 2 or
type 1 diabetes, your doctor may do a
C-peptide test or an autoantibodies test.
(Autoantibodies are produced when the body's
immune system does not work right.) For example, many people with type 1 diabetes produce the autoantibody zinc transporter 8 (ZnT8Ab). People with type 2 diabetes or gestational diabetes do not produce ZnT8Ab. These tests may
not be able to confirm the type of diabetes you have. Getting a
definite diagnosis may take months or years. In either case, your blood sugar
levels will need to be controlled right away.

Tests to monitor your health

You'll need to see your doctor every 3 to 6 months. At each visit you'll:

Check your blood pressure and start or adjust treatment if
your blood pressure is high. Nerve and blood vessel damage can result from high blood pressure, leading to heart problems and strokes. For more information, see the topic High Blood Pressure.

Have a hemoglobin A1c test. This blood test shows how steady your blood
sugar levels have been over time.

Your doctor might suggest a cholesterol and triglyceride test based on your age or your risk for heart disease. Talk to your doctor about when a cholesterol test is right for you.

These visits are also a good time to talk with your doctor about how you're feeling. It's normal to feel frustrated or overwhelmed with all there is to do. If you're having trouble coping, your doctor can help.

Tests to do every year

A complete eye exam by an
ophthalmologist or optometrist. High blood sugar levels from diabetes can damage your eyes. This test can find problems early, such as diabetic retinopathy. If you do not have any signs of diabetic retinopathy, your doctor may recommend less frequent exams, for example, every 2 years.

A foot exam for
signs of problems. Nerve damage in your feet makes it hard to feel an injury or infection. Take off your socks each time you see the doctor to be sure you both remember to check your feet.

A urine test, to check for protein. If protein is found, you'll have more tests to help guide the best treatment. Protein in the urine can be a sign of kidney damage (diabetic nephropathy).

Eye exams during pregnancy

If you get
pregnant, you will need to have an
eye exam sometime during the
first 3 months. You'll also need close follow-up
during your pregnancy and for 1 year after you
have your baby. Pregnancy increases your risk for diabetic retinopathy.footnote 1 If you already have eye disease and
get pregnant, the disease can quickly get
worse.

Treatment Overview

Your treatment for
type 2 diabetes will change over time to meet
your needs. But the focus of your treatment will always be
to keep your blood sugar levels within your target range. That will help prevent complications from type 2 diabetes,
such as eye, kidney, heart, blood vessel, and nerve disease.

See your doctor regularly. To help you stay on track with your treatment, you'll need
regular tests. For more information, see Exams and Tests.

Test your blood sugar.
It's important to track your blood sugar levels so you know if you are in your target range. For more information, see Living With Type 2 Diabetes.

Take medicines, if you need them. For more information, see Medications.

If you smoke, quit. Quitting can help you reduce your risk of heart disease and
stroke. For help, see the topic Quitting Smoking.

Keep high blood pressure and high cholesterol under control. Losing weight and getting plenty of
exercise, such as walking at least 2½ hours a
week, can help lower blood pressure. But you may also need to take
medicines, such as an
ACE inhibitor or beta-blocker, to achieve your
goal. You may also need to take cholesterol-lowering
medicines called
statins.

Making big changes like quitting smoking or changing the way you eat is hard. But you can do it if you set small goals and celebrate your successes. For help, see the topic Change a Habit by Setting Goals.

Pregnancy and breast-feeding

Your treatment may change if you get pregnant. For example, some medicines could harm your baby. If your blood sugar gets too high while you're pregnant, your baby might have problems at birth. Talk with your doctor.

Prevention

Many people have prediabetes before they have type 2 diabetes. If you're concerned about your risk, talk with your doctor. He or she will order tests to check your blood sugar levels. If you have prediabetes, you should be tested for type 2 diabetes every year. To learn more, see the topic Prediabetes.

You can take steps to prevent type 2 diabetes. Even small changes can make a difference, and it is never too late to start making healthier choices.

Stay at a healthy weight

A healthy weight is one that is right for your body type and height
and is based on your
body mass index (BMI) and the size of your waist (waist circumference). Losing just 7% of your body weight can help reduce
your risk for type 2 diabetes.footnote 1 If you
are age 20 or older, use the
Interactive Tool: Is Your BMI Increasing Your Health Risks? to check
your BMI. To use the tool, you'll need to know your height, weight, and waist circumference.

Exercise regularly

Do activities that raise your
heart rate. Try to do
moderate activity at least 2½ hours a week. Or try to
do
vigorous activity at least 1¼ hours a week. It's fine
to be active in blocks of 10 minutes or more throughout your day and week.

Also
include resistance exercises in your exercise program.footnote 2 Resistance exercises can include
activities like weight lifting or even yard work.

Walking groups or programs where you use a
pedometer to count the number of steps you take in a day are great ways to
start exercising and to stay motivated.

Using an
exercise planning form(What is a PDF document?) may help you and your doctor create a personalized exercise
program.

Take medicine if you need it

If exercise, eating healthy foods, and being at a healthy weight don't help lower your blood sugar, you may need to take medicine. For people who have prediabetes, the medicine metformin can help prevent type 2 diabetes.

Be careful with alcohol, which affects your blood sugar. It can make problems from nerve damage, blood pressure, cholesterol, and weight even worse. Adult women should limit alcohol to 1 drink a day with a meal. Adult men should limit alcohol to 2 drinks a day with a meal. And women who are pregnant should not drink at all.

Be active

You don't have to join a gym to get fit or be active. There are many things you can do, such as walking or even vacuuming.

Living and coping

Trying to manage your type 2 diabetes isn't easy.
Some days you may feel like it's just too much work to do everything you need
to do. There will be times when you just don't feel like testing and tracking
your blood sugar.

It's normal to feel sad
or even angry sometimes when you have a health problem. Even though you've had a while to get
used to the idea of having type 2 diabetes, you may still have trouble adjusting. You
may find it hard to
stay motivated.

When you feel sad, give yourself time to
adjust to your losses. If you feel overwhelmed,
just try to focus on one day at a time. Do the best you can. You don't have to
be perfect.

Get the support you need

If you're having trouble coping with your feelings,
try talking with a
counselor. A professional may make it easier to say
things you wouldn't talk about with friends or family.

If you have
symptoms of depression, such as a lack of interest in things you used to enjoy,
a lack of energy, or trouble sleeping, talk with your doctor. For more help,
see the topic
Depression.

You might also want to:

Talk with friends and family
about how you feel and any help you need.

Ask a friend or family member to come to counseling with
you.

Talk to your spiritual adviser if you
belong to a church or spiritual group. He or she will have experience helping
people deal with their feelings.

Join a support group. You can find one through your doctor, your local hospital, or the
American Diabetes Association.

One Man's Story:

Andy, 52

As a grocery manager, Andy
is on his feet all day. He also likes to bowl and play basketball with his
buddies. He started thinking about what he would do if he couldn't walk, work,
or play. "It finally just hit me how serious this disease is. I couldn't keep
ignoring it."—Andy

Medications

How medicine helps manage diabetes

Some people with
type 2 diabetes need medicines to help their bodies make insulin, decrease
insulin resistance, or slow down how quickly
their bodies absorb carbohydrate.

You may take no
medicine, one medicine, or a few medicines. Some people need to take medicine
for a short time, while others always need to take medicine. How much medicine
you need depends on how well you can keep your blood sugar within
your target range. You may need more medicine over time, even if you have good control of your blood sugar.

Medicines can help you manage your
type 2 diabetes and other health problems, but only if you
take them correctly. It can be hard to keep track of
when and how to take your medicine, especially if you are taking more than one.
Maybe you aren't sure why you are taking a medicine or if it is working. Or you
might have trouble paying for your medicine. For help, see the topic Quick Tips: Taking Medicines Wisely.

Medicine choices

Medicines that help your body make insulin. These include:

Sulfonylureas,
such as glipizide (Glucotrol), glyburide (DiaBeta, Glynase, and
Micronase), glimepiride (Amaryl), and other medicines that work in combination
(Glucovance, Metaglip).

Meglitinides,
such as repaglinide (Prandin), nateglinide (Starlix), and a
combination medicine (Prandimet).

Medicines that help lower blood sugar. If you are having trouble controlling your blood
sugar with pills, your doctor may suggest one of these medicines:

Incretin mimetics, such as
exenatide (Byetta) and liraglutide (Victoza). You take this medicine as a shot.

Amylinomimetics, such as pramlintide (Symlin). This
medicine works with insulin and
glucagon to help control blood sugar. It
is given as a shot before meals.

Medicine that helps your kidneys remove glucose.

Sodium glucose co-transporter 2 inhibitors (SGLT2 inhibitors), such as canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance). This medicine helps to remove extra glucose through urine. It may also help some people lose weight.

Insulin.
Insulin lets sugar (glucose) in the blood enter cells, where it is
used for energy. Without insulin, the blood sugar level gets too high. Most of the time, people who take
insulin use a combination of
short-acting and long-acting insulin. This helps keep
blood sugar within the target range. You may want to learn
more about
when insulin is needed for type 2 diabetes.

Phosphodiesterase-5 inhibitors (PDE-5 inhibitors), such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis), if you have erection
problems. Check with your doctor before taking any of these
medicines.

Fibrates, such as fenofibrate
(Tricor) or gemfibrozil (Lopid), to help lower triglycerides and increase HDL levels.

Medicines for digestive problems. The type of medicine
will depend on the problem you are having. For example, if you have
gastroparesis, you may take metoclopramide
(Reglan) or erythromycin.

Nonprescription pain relievers,
creams, or prescription oral or injection medicines if you have pain from
peripheral neuropathy.

If you hear about something new to help type 2 diabetes, do some research to find out if it really works. You can also check with your doctor or a
diabetes educator. Your health plan may also provide health information on its website.

These sources present information that is based on the analysis of a large body of medical evidence:

Agency for Healthcare Research and Quality (AHRQ)

Centers for Disease Control and Prevention (CDC)

American Diabetes Association

Complementary therapies

Some complementary
therapies may help relieve stress and muscle tension. They might help you feel better in general. But
they shouldn't be used as your only treatment for type 2 diabetes.

Centers for Disease Control and Prevention (2014). National diabetes statistics report: Estimates of diabetes and its burden in the United States, 2014. Centers for Disease Control and Prevention. http://www.cdc.gov/diabetes/pubs/statsreport14.htm. Accessed July 10, 2014.

Kaul S, et al. (2010). Thiazolidinedione drugs and cardiovascular risks: A science advisory from the American Heart Association and American College of Cardiology Foundation. Circulation, 121(16): 1868–1877.

Pignone M, et al. (2010). Aspirin for primary prevention of cardiovascular events in people with diabetes: A position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation, 121(24): 2694–2701.

Skyler JS, et al. (2009). Intensive glycemic control and the
prevention of cardiovascular events:
Implications of the ACCORD, ADVANCE,
and VA Diabetes Trials: A position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care, 32(1), 187–192.

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How this information was developed to help you make better health decisions.